100%(6)6 out of 6 people found this document helpful
This preview shows page 9 - 11 out of 14 pages.
VASCULAR SURGERYFEMORAL-POPILTEAL(FEMPOP) BYPASSPost-op:•Uses saphenous vein or internal mammary artery•Sternotomy opens chest•Placed on bypass machine; heart is stopped•Chest tubes and temporary pacing wires inserted•On vent with a-line, swanz-ganz line for 1st day•Ventilator set up, obtain initial blood gases•ECG monitor•Suction applied to chest drains and NGT if present•Warm patient on arrival (As patient warms, vasodilates, watch BP)•Ensure drug/fluid infusions are given according to prescription, labelled correctly and are infusing at correct rate•Commence epidural monitoring if patient has a thoracic epidural - every hour•Central lines are secure- Central Line, Arterial Line,· Swan Ganz Catheter•Assess surgical sites (chest & legs) (Jackson-pratt/hemovac to legs)•Assess every hour airway, breathing, blood gases, fluids, drugs, circulation, bleeding, sedation, pain levels, patient awareness, patient pychological state, wound condition and oral hygiene Hourly output (report UO<30cc. CT>100) May replace CT drainage with blood•Post-op: in ICU 1 day, in hospital 4-5•Extubated same day or 1st post op day; reinforce pulmonary toilet•Swan-ganz and a-line out after 1 day•Manage surgical pain; splint chest for C & DB•Monitor incisions sites•Get OOB 1st post-op day; increase activity as tolerated•Advance to cardiac diet once peristalsis resumes•Chest tube out after 2 days•Temporary pacing wires (covered with non-conducting material to prevent accidental charge) removed day 2Discharge teaching:•Similar to post-MI (review NUR105 notes)•Cardiac diet•Coughing, deep breathing, IS•No lifting (especially on side of internal mammary artery) for 2-3 months•No driving 6 weeks•Report angina, rapid weight gain (weigh daily), excessive fatigue, palpitations, dizziness•Teach adaptations of wound infection•Cardiac rehab to slowly rebuild activity toleranceComplications CABG:•Graft leakage: hypotension, large CT drainage—may need surgery; may need protamine sulfate to reverse heparin•Post-Pump psychosis: Haldol; get out of ICU; safety measures (restraints, observation, orientation)•Cardiac tamponade: distended neck veins, decreased pulse pressure with hypotensioon, tachycardia, muffled heart sounds, anxiety, check CT drainage—may need surgery•Dysrhythmias (check K+ and PaO2)•Hypovolemia: Volume expanders (FFP) & blood•may need vasopressors (dopamine, dobutamine, epinephrine, norepinephrine (Levophed), vasopressin (Pitressin), milrinone (Primacor)•PE or CVA•Fever: atelectasis and infectionInterventions: surgical:•Angioplasty (with or without stents)•Endarterectomy (removal of lining of vessel along with clot & plaque)•Bypass graft (may use saphenousvein or artificial material)•Amputation•Watch for hemorrhage and infection•Monitor peripheral circulation•Avoid leg crossing or long periods of standing•Minor edema OK •Be careful with compression stockings not pressing on graft9
CARDIOVASCULAR MEDICATIONSDiuretics:•loop diuretics –Lasix (furosemide) Bumex(bumetanide)—IV/POtx—fast acting excreting of fluid and electrolytes via kidney